Healthcare Provider Details

I. General information

NPI: 1770709305
Provider Name (Legal Business Name): COMMUNITY SENIORSERV, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 N KNOLLWOOD CIR
ANAHEIM CA
92801-1307
US

IV. Provider business mailing address

1200 N KNOLLWOOD CIR
ANAHEIM CA
92801-1309
US

V. Phone/Fax

Practice location:
  • Phone: 714-220-2114
  • Fax: 714-220-1406
Mailing address:
  • Phone: 714-220-0224
  • Fax: 714-816-7397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number060000244
License Number StateCA

VIII. Authorized Official

Name: HOLLY HAGLER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 714-823-3285